Provider Demographics
NPI:1558680975
Name:COMMUNITY SUPPORT SPECIALISTS, LLC
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:DELLA
Authorized Official - Last Name:KENION
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-763-3644
Mailing Address - Street 1:1316 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6422
Mailing Address - Country:US
Mailing Address - Phone:910-763-3644
Mailing Address - Fax:910-763-3634
Practice Address - Street 1:1316 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6422
Practice Address - Country:US
Practice Address - Phone:910-763-3644
Practice Address - Fax:910-763-3634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management